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Feedback Survey

3. How often do you visit this website?
First time
Less than once a month
Once or more a month
Once or more a week
Daily

4. What type of information were you looking for today?
If other, what?

5. DeterminedToQuit.com's Quit Companion offers support messages to
those who are attempting to quit. How would you like to receive these messages?
(Check all that apply. This does not mean you will start receiving messages.)
EMail
Text Message
Phone Call
None

6. Was there anything you were looking for but couldn't find?
Yes
No
If yes, what?

7. How can we improve this website?

Some information about yourself

1. Age?
Under 18 years of age
18-24 years old
25-34 years old
35-49 years old
50-64 years old
65+ years of age

2. Gender?
Male
Female

3. Which of the following best describes your race/ethnicity?
Asian & Pacific Islander
Black
Hispanic / Latino
White
Prefer Not to Answer

4. Highest level of education?

5. What is your annual household income?

6. Are you a resident of Pennsylvania?
Yes
No
If yes, in which county do you live?

7. Average time spent online each week for personal use, including email?

8. If you use tobacco products, which of the following statements best describe your current mindset?